A newly developed socket design for a knee disarticulation amputee who is an active athlete

Adjustable prosthetic sockets: a systematic review of industrial and research design characteristics and their justifications

BACKGROUND

The prosthetic socket is a key component that influences prosthesis satisfaction, with a poorly fitting prosthetic socket linked to prosthesis abandonment and reduced community participation. This paper reviews adjustable socket designs, as they have the potential to improve prosthetic fit and comfort through accommodating residual limb volume fluctuations and alleviating undue socket pressure.

METHODS

Systematic literature and patent searches were conducted across multiple databases to identify articles and patents that discussed adjustable prosthetic sockets. The patents were used to find companies, organisations, and institutions who currently sell adjustable sockets or who are developing devices.

RESULTS

50 literature articles and 63 patents were identified for inclusion, representing 35 different designs used in literature and 16 commercially available products. Adjustable sockets are becoming more prevalent with 73% of publications (literature, patents, and news) occurring within the last ten years. Two key design characteristics were identified: principle of adjustability (inflatable bladders, moveable panels, circumferential adjustment, variable length), and surface form (conformable, rigid multi-DOF, and rigid single DOF). Inflatable bladders contributed to 40% of literature used designs with only one identified commercially available design (n = 16) using this approach. Whereas circumferential adjustment designs covered 75% of identified industry designs compared to only 36% of literature devices. Clinical studies were generally small in size and only 17.6% of them assessed a commercially available socket.

DISCUSSION

There are clear differences in the design focus taken by industry and researchers, with justification for choice of design and range of adjustment often being unclear. Whilst comfort is often reported as improved with an adjustable socket, the rationale behind this is not often discussed, and small study sizes reduce the outcome viability. Many adjustable sockets lack appropriate safety features to limit over or under tightening, which may present a risk of tissue damage or provide inadequate coupling, affecting function and satisfaction. Furthermore, the relationship between design and comfort or function are rarely investigated and remain a significant gap in the literature. Finally, this review highlights the need for improved collaboration between academia and industry, with a strong disconnect observed between commercial devices and published research studies.

A novel characterisation protocol of mechanical interactions between the ground and a tibial prosthesis for long jump

The mechanical study of Running Specific Prostheses (RSPs) is often limited to the blade. The setup developed and presented herein is a simple experiment, based on a mechanical testing machine and a camera, that assesses two indicators relevant to coaches and athletes in the field of athletics: secant stiffness and energy dissipation. The influence of four parameters on global prosthesis behaviour is evaluated: the load line offset, the prosthesis-ground angle, the sole type and the flooring type. The load line offset and the flooring type have little to no influence on their behaviour. The prosthesis-ground angle impacts the stiffness: an increase in the angle brings a significant decrease in stiffness, which strongly impacts the performance. The type of sole modifies the kinematics of the blade tip's interaction with the ground. However, this effect is less likely to enhance the sports practice since athletics imposes the use of spikes. The camera images allow assessing the local behaviour of the sole, thus enabling to follow its strain through the compression process.

Development of high performance parasport prosthetic limbs: A proposed framework and case study

Sport with a disability has progressed from undertaking physical activity for recreation to one of a high performance environment at competitions such as the Paralympic Games. There is currently limited information and guidance to help inform stakeholders as to how to develop the high performance technology of elite athletes who possess limb absence. In this manuscript, a conceptual framework for high performance prosthetic limb creation is presented. This utilises a synthesis between contemporary product design theory and a review of existing case studies. This proposed framework is then applied to a case study. Ultimately, the framework provides an indicative guide to the creation of prosthetic limbs that emphasise technological performance enhancement over that of mere sporting participation.

An investigation into the relationship between paracycling athletes and their prosthetics technology: a proposed design framework

Objective: Product attachment has been stated as an emotional relationship an end-user may develop with a tangible product or artefact. The objective of this study is to investigate this relationship with athletes who possess limb absence and utilise assistive sports technology competitively.Method: Five elite paracyclists were surveyed using a modified 31 question product attachment survey. The survey comprised the ability to capture both closed-ended and open-ended data. The survey design itself was derived from three previously validated product relationship questionnaires.Results: Four elite athletes with limb absence did not provide any firm evidence or indication to support the concept of a non-physical relationship with their prosthetic device. However, some respondents had (or wished) to incorporate some form of aesthetic-based prosthetic personalisation or customisation, as long as this did not impact on the prostheses functional performance. Furthermore, a thematic analysis of the participant's responses yielded a four-point assistive technology design philosophy framework. The emerging thematic areas were 1) The identification of the factors that influence performance in the athletes chosen sport; 2) To consider an 'appearance follows performance' approach; 3) To conduct sports specific trials of the prosthetic limb; and 4) To identify any need for prostheses decorative personalisation.Conclusions: The survey revealed some anecdotes of a sports technology to user relationship but this will require further exploration with different and larger sample populations. Use of the proposed four-point framework may help inform practitioners of what considerations could provide greater end-user satisfaction when designing and developing specialised prosthetic limbs for elite-level sport.Implications for rehabilitationWhilst the formal characteristics of product attachment were not broadly identified in this study, some indications may give credence for prosthetists to consider an "appearance follows performance" approach to sports prostheses design. This may improve end-user satisfaction with their assistive technology.The inclusion of prosthetic post-manufacture decoration and personalization would seem to be desirable to the end-user.By adopting the feedback given in this study, undertaking trials conducted at a race-specific intensity of the athlete end-user may reduce the need to perform post-manufacture ad-hoc prostheses modifications.

Innovative Techniques for Maximizing Limb Salvage and Function

Concurrent injuries to multiple extremities present unique challenges to the reconstructive surgeon. The primary goal in such scenarios is to optimize functional outcomes. The goal of this article is to present an overview of various techniques necessary to provide sufficient soft tissue and preserve amputation limb lengths and function. The concept of innovative techniques for maximizing limb savage and function is presented using an index patient with multiple extremity third- and fourth-degree burn injuries resulting in nonsalvageable lower extremities and severe left-hand wounds. A review of other potential innovative techniques is discussed. The burn injury resulted in a need for bilateral guillotine below-knee amputations. Above-knee amputation was avoided in the left leg using a parascapular free fasciocutaneous flap, while through-knee amputation was preferred to above-knee amputation in the right leg. The preservation of areas with questionable viability resulted in salvaging the left hand of the patient using digital palmar flaps to resurface the dorsum with creation of a first web-space. Maintenance of maximal viable length of limbs and any residual function in the limbs can be of significant functional benefit to multiple limb amputation patients. Maximizing the limb length in such patients is critical, and typical "rules" that have traditionally been utilized to minimize numbers of operations and optimize prosthetic fit may not apply.

Sport prostheses and prosthetic adaptations for the upper and lower limb amputees: an overview of peer reviewed literature

BACKGROUND

Sport prostheses are used by both upper- and lower-limb amputees while participating in sports and other physical activities. Although the number of these devices has increased over the past decade, no overview of the peer reviewed literature describing them has been published previously. Such an overview will allow specialists to choose appropriate prostheses based on available scientific evidence rather than on personal experience or preference.

OBJECTIVE

To provide an overview of the sport prostheses as they are described by the papers published in peer reviewed literature.

STUDY DESIGN

Literature review.

METHODS

Four electronic databases were searched using free text and Medical Subject Headings (MESH) terms. Papers were included if they concerned a prosthesis or a prosthetic adaptation used in sports. Papers were excluded if they did not originate from peer reviewed sources, if they concerned prostheses for body parts other than the upper or lower limbs, if they concerned amputations distal to the wrist or ankle, or if they were written in a language other than English.

RESULTS

Twenty-four papers were included in this study. The vast majority contained descriptive data and consisted of expert opinions and technical notes.

CONCLUSION

Data concerning the energy efficiency, technical characteristics and special mechanical properties of prostheses or prosthetic adaptations for sports, other than running, are scarce.